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News & AnnouncementsTesting for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated December 15, 2022)12/15/2022Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Medicare Advantage Members (Updated December 15, 2022)
News & Announcements01/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products12/30/202201/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Medicare Advantage Products
NotificationseviCore Lab ManagementMA06.034h12/2/2022 11:00 AM1/1/202312/2/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateeviCore Lab Management
NotificationsNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)MA05.058c12/2/2022 1:00 PM1/2/202312/2/2022Coverage and/or Reimbursement Position;Medical CodingNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
NotificationsTranscranial Magnetic Stimulation (TMS)MA07.035d12/5/2022 5:00 PM1/1/202312/5/2022Medical Necessity CriteriaTranscranial Magnetic Stimulation (TMS)
NotificationsImplantable and External Infusion PumpsMA05.053k12/19/2022 2:00 PM1/18/202312/19/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateImplantable and External Infusion Pumps
New PoliciesRapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic DisordersMA06.0351/1/202312/15/2022This is a New Policy.Rapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders
New PoliciesSpesolimab--sbzo (Spevigo®)MA08.15512/19/202212/19/2022This is a New Policy.Spesolimab--sbzo (Spevigo®)
New PoliciesPsychological TestingMA14.00211/1/2022 9:00 AM1/1/202312/30/2022This is a New Policy.Psychological Testing
New PoliciesElectroconvulsive Therapy (ECT)MA14.00111/1/2022 12:00 PM1/1/202312/30/2022This is a New Policy.Electroconvulsive Therapy (ECT)
Updated PoliciesOstomy SuppliesMA05.014d11/4/2022 9:00 AM12/5/202212/5/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateOstomy Supplies
Updated PoliciesMusculoskeletal ServicesMA00.047g12/5/2022Coverage and/or Reimbursement Position;Medical Necessity CriteriaMusculoskeletal Services
Updated PoliciesContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesMA00.002i12/5/202212/5/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateContinuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
Updated PoliciesHigh-Technology Radiology ServicesMA09.002x11/6/202212/5/2022General Description, Guidelines, or Informational UpdateHigh-Technology Radiology Services
Updated PoliciesPercutaneous Coronary Intervention, Coronary Angiography and Arterial UltrasoundMA11.113f11/6/202212/5/2022General Description, Guidelines, or Informational UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound
Updated PoliciesX-rays Associated with Fractures in the Office SettingMA00.031f12/5/202212/5/2022Coverage and/or Reimbursement PositionX-rays Associated with Fractures in the Office Setting
Updated PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006h12/5/202212/5/2022Medical Coding;General Description, Guidelines, or Informational UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010aj12/5/202212/5/2022Coverage and/or Reimbursement PositionPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Updated PoliciesNever Events and Preventable Serious Adverse EventsMA00.039e12/5/202212/5/2022General Description, Guidelines, or Informational UpdateNever Events and Preventable Serious Adverse Events
Updated PoliciesAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringMA07.026j12/9/202212/9/2022General Description, Guidelines, or Informational UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Updated PoliciesEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related BiosimilarsMA08.082i11/18/2022 9:00 AM12/19/202212/19/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
Updated PoliciesIn Vitro Allergy TestingMA06.002c11/18/2022 10:00 AM12/19/202212/19/2022Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateIn Vitro Allergy Testing
Updated PoliciesSpeech and Non-Speech Generating DevicesMA05.003e12/19/202212/19/2022Medical Necessity CriteriaSpeech and Non-Speech Generating Devices
Updated PoliciesTafasitamab-cxix (Monjuvi®)MA08.138a12/19/202212/19/2022Medical Necessity CriteriaTafasitamab-cxix (Monjuvi®)
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)MA08.066f12/19/202212/19/2022Medical Necessity CriteriaAdo-Trastuzumab Emtansine (Kadcyla®)
Updated PoliciesReduction MammoplastyMA11.069d12/19/202212/19/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateReduction Mammoplasty
Updated PoliciesSurgery for GynecomastiaMA11.110a12/19/202212/19/2022Medical Necessity CriteriaSurgery for Gynecomastia
Updated PoliciesScar RevisionMA11.078c12/19/202212/19/2022Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational UpdateScar Revision
Updated PoliciesReimbursement for Radiopharmaceutical Agents for Professional ProvidersMA09.009r12/19/202212/19/2022Medical CodingReimbursement for Radiopharmaceutical Agents for Professional Providers
Updated PoliciesLoncastuximab tesirine-lpyl (Zynlonta®)MA08.139b12/19/202212/19/2022Medical Necessity CriteriaLoncastuximab tesirine-lpyl (Zynlonta®)
Updated PoliciesPolatuzumab vedotin-piiq (Polivy®)MA08.108d12/19/202212/19/2022Medical Necessity CriteriaPolatuzumab vedotin-piiq (Polivy®)
Updated PoliciesCemiplimab-rwlc (Libtayo®)MA08.124b12/19/202212/19/2022Medical Necessity CriteriaCemiplimab-rwlc (Libtayo®)
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)MA08.113d12/19/202212/19/2022Medical Necessity CriteriaEnfortumab vedotin-ejfv (Padcev®)
Updated PoliciesAvelumab (Bavencio®)MA08.122b12/19/202212/19/2022Medical Necessity CriteriaAvelumab (Bavencio®)
Updated PoliciesChemical PeelsMA11.103b9/26/2022 2:00 PM12/26/202212/26/2022Coverage and/or Reimbursement PositionChemical Peels
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related BiosimilarsMA08.073j1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)MA08.083h1/31/202212/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateGonadotropin-Releasing Hormone Agonist (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)
Updated PoliciesHome-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)MA05.022a11/1/2022 10:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateHome-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Updated PoliciesCranial Electrotherapy StimulationMA05.066c11/1/2022 10:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateCranial Electrotherapy Stimulation
Updated PoliciesDurvalumab (Imfinzi®)MA08.123b1/2/202312/30/2022Coverage and/or Reimbursement PositionDurvalumab (Imfinzi®)
Updated PoliciesIntravenous Infliximab and Related BiosimilarsMA08.019l1/2/202312/30/2022Medical Necessity Criteria;Medical CodingIntravenous Infliximab and Related Biosimilars
Updated PoliciesAcute Care Facility Inpatient TransfersMA12.003b11/1/2022 11:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateAcute Care Facility Inpatient Transfers
Updated PoliciesCapsule EndoscopyMA07.022e1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateCapsule Endoscopy
Updated PoliciesPertuzumab (Perjeta®)MA08.063f1/2/202312/30/2022Medical Necessity CriteriaPertuzumab (Perjeta®)
Updated PolicieseviCore Lab ManagementMA06.034h12/2/2022 11:00 AM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateeviCore Lab Management
Updated PoliciesTranscranial Magnetic Stimulation (TMS)MA07.035d12/5/2022 5:00 PM1/1/202312/30/2022Medical Necessity CriteriaTranscranial Magnetic Stimulation (TMS)
Updated PoliciesVagus Nerve Stimulation (VNS)MA11.019h11/1/2022 12:00 PM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update12/30/2022Vagus Nerve Stimulation (VNS)
Updated PoliciesDeep Brain Stimulation (DBS)MA11.005e11/1/2022 12:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateDeep Brain Stimulation (DBS)
Updated PoliciesProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)MA11.055f1/2/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Updated PoliciesWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing WoundsMA11.015s1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Updated PoliciesPresumptive and Definitive Drug Testing in Substance Abuse and Pain Management TreatmentsMA06.025p11/1/2022 2:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational UpdatePresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Updated PoliciesTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, and AntiepilepticsMA06.029a11/1/2022 2:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, and Antiepileptics
Updated PoliciesPreventive Care ServicesMA00.003u1/1/202312/30/2022Medical Necessity CriteriaPreventive Care Services
Updated PoliciesIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)MA08.137a11/1/2022 9:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational UpdateIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
Updated PoliciesCetuximab (Erbitux®)MA08.031f1/2/202312/30/2022Medical Necessity CriteriaCetuximab (Erbitux®)
Coding UpdateCobalamin (Vitamin B12), Folic Acid, and Homocysteine TestingMA06.032a10/1/202212/7/2022Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringMA07.026k1/1/202312/30/2022Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Coding UpdateContinuous Glucose Monitors and Home Blood Glucose Monitors and SuppliesMA00.002j1/1/202312/30/2022Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
Coding UpdateUpper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)MA07.023h1/1/202312/30/2022Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Coding UpdatePercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass SurgeryMA11.056g1/1/202312/30/2022Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Coding UpdateArtificial Intervertebral Lumbar Disc InsertionMA11.114b1/1/202312/30/2022Artificial Intervertebral Lumbar Disc Insertion
Coding UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial UltrasoundMA11.113g1/1/202312/30/2022Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound
Coding UpdateAprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)MA08.091e1/1/202312/30/2022Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Coding UpdateAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaMA11.105j1/1/202312/30/2022Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Coding UpdateDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyMA11.099c1/1/202312/30/2022Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Coding UpdateFecal Microbiota Transplantation (FMT)MA07.006c1/1/202312/30/2022Fecal Microbiota Transplantation (FMT)
Coding UpdateBevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMA08.072k1/1/202312/30/2022Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030aa1/1/202312/30/2022Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Coding UpdateRisankizumab-rzaa (Skyrizi®) for Intravenous UseMA08.153a1/1/202312/30/2022Risankizumab-rzaa (Skyrizi®) for Intravenous Use
Coding UpdateBortezomib (Bortezomib for Injection, Velcade®)MA08.037i1/1/202312/30/2022Bortezomib (Bortezomib for Injection, Velcade®)